Healthcare Provider Details

I. General information

NPI: 1992071344
Provider Name (Legal Business Name): SYNCHRONY OF VISALIA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2012
Last Update Date: 03/30/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1041 N DEMAREE ST
VISALIA CA
93291-4119
US

IV. Provider business mailing address

1041 N DEMAREE ST
VISALIA CA
93291-4119
US

V. Phone/Fax

Practice location:
  • Phone: 559-635-4281
  • Fax:
Mailing address:
  • Phone: 559-635-4281
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. EDWYN ORTIZ-NANCE
Title or Position: PSYCHOLOGIST
Credential: PSY.D.
Phone: 559-635-4252